个案管理在肺癌PICC置管患者化疗间歇期延伸护理服务中的应用

目的:探讨个案管理在肺癌PICC置管患者化疗间歇期延伸护理服务中的应用效果。方法:将2016年10月1日～2018年8月31日收治的104例肺癌PICC置管化疗患者按照入院顺序分为观察组和对照组各52例,对照组实施常规护理,观察组在常规护理基础上给予个案管理的延伸护理服务;比较两组自护能力评分、导管相关性血流感染发生率、护理满意度、干预前后自我效能评分[采用中文版癌症自我管理效能量表(SUPPH)]。结果:观察组自护信心、自护依从性、导管维护能力、异常情况处置评分高于对照组(P0.01);观察组导管相关性血流感染发生率低于对照组(P0.05),护理满意度高于对照组(P0.05);干预后,两组自我决策、自我减压、正性态度评分高于干预前(P0.05),且观察组高于对照组(P0.05)。结论:在延伸护理服务中采取个案按理方案有利于提高肺癌PICC置管患者化疗间歇期自护能力,降低导管相关性血流感染发生率,提高患者自我效能,且护理满意度高。     

针对性护理在白血病化疗患儿PICC置管中的应用

目的:探讨针对性护理在白血病化疗患儿经外周穿刺中心静脉置管(PICC)中的应用效果。方法:将88例接受PICC置管的白血病化疗患儿,采用随机分组方式分为对照组和观察组各44例,对照组采用常规肿瘤化疗模式进行护理,观察组采用针对性护理干预,比较两组PICC导管相关性血流感染发生率、治疗时间及家属对护理满意度。结果:观察组PICC导管相关性血流感染发生率、治疗时间及护理满意度均优于对照组(P0.05)。结论:对接受化疗的白血病患儿实施针对性护理干预,可有效预防PICC导管相关性血流感染发生,缩短治疗时间,从而提高家属对护理满意度。     

PICC置管前评估与综合护理在肺癌化疗患者中的应用

目的:探讨经外周静脉置入中心静脉导管(PICC)置管前评估与综合护理在肺癌化疗患者中的应用效果。方法:将2018年1月1日～2019年12月31日进行PICC置管化疗的80例肺癌患者随机分为观察组和对照组各40例,对照组患者采用常规护理方式,观察组患者采用PICC置管前评估与置管综合护理。比较两组患者置管效果、并发症发生率和生活质量。结果:观察组患者置管效果优于对照组(P0.05);观察组患者并发症发生率低于对照组(P0.01);观察组患者生活质量评分高于对照组(P0.01)。结论:PICC置管前评估,并根据评估结果进行置管综合护理,有利于提高一次性穿刺成功率、减少术后并发症的发生,为肺癌患者提供高质量的护理。     

优质护理在PICC置管肿瘤患者中的应用

目的:探讨优质护理在PICC置管肿瘤患者中的应用效果。方法:将收治的肿瘤患者118例随机分为观察组和对照组各59例,对其化疗期间实施PICC置管,观察组提供患者优质护理,对照组仅给予患者常规护理。比较两组住院2周后的焦虑情况和心理健康状况,以及PICC置管穿刺点红肿、出血,导管渗液,机械性静脉炎,导管相关性血液感染以及非计划性拔管等并发症发生情况。结果:观察组焦虑情况和心理健康状况较对照组明显改善,穿刺点红肿发生率、机械性静脉炎发生率、导管相关性血流感染率以及非计划拔管率明显降低(P0.05)。结论:对肿瘤化疗期间PICC置管患者实施优质护理,能够有效减轻其焦虑情绪,调节心理状态,减少并发症发生,改善生活质量。     

信息护理健康教育联合结构式心理干预在肝癌化疗PICC置管患者中应用

目的探究肝癌化疗PICC置管患者应用信息护理健康教育联合结构式心理干预的效果。方法选2015年4月—2019年4月肝癌化疗PICC置管患者76例,依据组间基本资料具有可比性的原则等分为对照组和观察组,对照组采用常规护理,观察组采用基于IIFAR方案信息干预联合结构式心理干预,比较两组PICC置管过程中并发症发生率、心理状态变化评分。结果观察组PICC置管导管堵塞、血栓、导管移位、穿刺位置感染等并发症发生率明显低于对照组(P<0.05);观察组自尊感、愤怒、精力、疲劳、混乱、紧张及抑郁等心理状态评分明显高于对照组(P<0.05)。结论肝癌化疗PICC置管患者应用基于IIFAR方案信息干预联合结构式心理干预,提高患者对疾病相关知识的认识,强化对置管期间行为习惯的管理能力,缓解自身不良情绪,减少置管并发症的发生。     

60例结直肠癌辅助化疗中PICC置管并发症的护理研究

选取2012年12月~2014年12月来我院就诊的120例行PICC置管辅助化疗的结直肠癌患者。分为对照组和研究组各60例。对照组行常规护理,观察组正常规护理基础上给予了PICC置管并发症的护理。比较两组在导管脱出、导管堵塞、静脉炎、导管相关性感染、等PICC置管并发症发生率方面的差异。结果研究组中的结直肠癌患者的导管脱出、导管堵塞、静脉炎、导管相关性感染、等一系列PICC置管并发症的发生率要显著低于对照组患者,差异具有统计学意义(P<0.05)。对进行PICC置管的结直肠癌辅助化疗的患者采取并发症的护理模式可以有效的减少化导管脱出、导管堵塞、静脉炎、导管相关性感染等一系列并发症的发生,并能有效的减轻患者的痛苦,提高患者的生活质量。     

预见性分阶段干预对肺癌PICC置管化疗患者CRBSI发生率的影响分析

目的探讨预见性分阶段干预对肺癌PICC置管化疗患者血管内导管相关血流感染(CRBSI)发生率的影响。方法选取2017年3月～2020年4月我院肺癌患者73例,按入院时间不同分观察组38例和对照组35例。均行PICC置管化疗治疗,对照组予以常规护理干预,观察组在对照组基础上予以预见性分阶段干预,对比两组CRBSI发生率、干预满意度、干预前后相关知识知晓情况。结果观察组CRBSI发生率0.00%,与对照组的8.57%比较差异无统计学意义(P0.05);干预后观察组置管目的、留管安全管理、注意事项得分均高于对照组,差异均有统计学意义(P0.05);观察组干预满意度为94.74%,高于对照组的71.43%,差异有统计学意义(P0.05)。结论肺癌PICC置管化疗患者予以预见性分阶段干预可提高相关知识知晓情况,降低CRBSI发生风险,提升对护理服务认可度。     

循证护理在PICC置管患者护理中的应用及对导管感染的相关性研究

目的研究循证护理在经PICC患者护理中的应用及其与降低导管相关性感染的关系。方法研究对象选取我科2016年3月到2017年3月间收治的PICC置管患者108例,随机分为对照组和观察组,每组54例。对照组采用常规护理方法,在此基础上,观察组采用循证护理方法。比较两组的护理满意度、导管相关性感染的发生情况及置管时间。结果护理后,观察组的导管感染所致相关并发症发生率明显低于对照组(P0.01);观察组护理满意度明显高于对照组(P0.05)。结论相比常规护理,对PICC置管患者进行循证护理能获得更高的满意度,置管效果更明显,且能明显减少PICC患者导管相关性感染的发生,延长置管时间,值得在临床推广。     

外周导入中心静脉置管与中心静脉置管并发症的比较

目的比较外周导入中心静脉置管(penlpherally inserted central catheter,PICC)与中心静脉置管(central venous catheter,CVC)的并发症,为置管前宣教和置管后护理提供根据.方法将92例恶性肿瘤患者分2组,A组(n=52)采用PICC置管;B组(n=40)采用CVC置管,比较2组并发症的发生率.结果A组静脉炎、导管堵塞、导管脱出、静脉血栓形成发生率明显高于B组,B组导管相关感染,导管断裂发生率高于A组.结论肿瘤终末期、机体抵抗力差、长时间卧床的患者行PICC置管较为方便;需要长时间化疗.化疗间歇期需要适当活动,特别是乳腺癌术后术侧肢体需要锻炼的患者,以CVC置管为宜.行CVC置管时,正确固定、严格换药十分重要.     

肿瘤化疗患者外周中心静脉置管并发症及其相关因素的影响

目的对肿瘤化疗患者外周中心静脉(PICC)置管的并发症及造成这种并发症的相关因素进行分析,为减少和预防并发症的发生提供理论依据。方法以2011年3月至2014年9月来该院进行肿瘤化疗的127例化疗并行PICC置管的患者为研究对象,对其发生的并发症及导致并发症发生的相关因素进行分析。结果 127例行PICC置管患者中,17例患者发生机械性静脉炎,发生率13.38%,8例发生导管相关性感染,发生率为6.29%,7例发生导管堵塞,发生率5.51%;头臂静脉PICC置管静脉炎的发生率为60.00%,明显高于贵要静脉2.41%和正中静脉20.70%,差异有统计学意义(P0.05);常规护理维护模式导管相关性感染的发生率为11.11%,明显高于3M换药模式护理1.56%,差异有统计学意义(P0.05)。结论肿瘤化疗患者进行PICC置管治疗容易产生并发症,而正确的穿刺方法、选择合适的穿刺部位及采取有效的护理能够减少机械性静脉炎、导管相关性感染及导管堵塞等并发症的发生。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.